Provider Demographics
NPI:1134293244
Name:JOHNSON LABORATORY INC
Entity Type:Organization
Organization Name:JOHNSON LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:BEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-3971
Mailing Address - Street 1:660 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812
Mailing Address - Country:US
Mailing Address - Phone:740-622-3971
Mailing Address - Fax:740-622-5150
Practice Address - Street 1:660 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812
Practice Address - Country:US
Practice Address - Phone:740-622-3971
Practice Address - Fax:740-622-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4425812Medicaid
OH4425812Medicaid